Small diameter linear surgical stapling apparatus

ABSTRACT

-- A surgical stapling apparatus includes a housing assembly, an elongated shaft assembly, an anvil assembly, a cartridge assembly, and a firing drive screw coupled to a firing nut. The elongated shaft assembly defines a longitudinal axis and has a distal end portion and a proximal end portion. The proximal end portion is selectively attached to the housing assembly. The anvil assembly is supported on the distal end portion of the elongated shaft assembly. The cartridge assembly is selectively attached to the anvil assembly to secure the cartridge assembly to the elongated shaft assembly. The firing nut is coupled to a firing tube. The firing tube is coupled to a firing rod. The firing rod is positioned to advance a drive beam assembly through the cartridge assembly.--

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Pat. Application No.17/407,623, filed on Aug. 20, 2021, the entire contents of which areincorporated by reference herein.

TECHNICAL FIELD

This disclosure relates to surgical stapling apparatus and, moreparticularly, to surgical stapling apparatus configured to rotate,articulate, and fire within small diameter (e.g., 8 mm) passages.

BACKGROUND

Fasteners have traditionally been used to replace suturing when joiningvarious body structures. Surgical stapling apparatus employed to applythese fasteners are generally designed to simultaneously cut and sealtissue to reduce the time and risks involved with surgical procedures.Surgical stapling apparatus that clamp, cut and/or staple tissue arewell known in the art. Such surgical stapling apparatus include endeffectors having two elongated jaw members used to capture or clamptissue. These end effectors can be provided in the form of an elongateloading unit removably attachable to a housing assembly via an adapterto enable drive components of the housing assembly to operate the endeffector in vivo, for instance, laparoscopically. In particular, one ofthe two jaw members of the end effector usually carries a staplecartridge that houses a plurality of staples positioned in rows, whilethe other of the two jaw members has an anvil for forming the staples asthe staples are driven from the staple cartridge. In linear surgicalstapling apparatus, for example, a stapling operation is effectuated bya cam bar, a drive sled or other similar mechanism having a cam memberthat travels longitudinally through channels defined in the staplecartridge and acts upon staple pushers in the channels to sequentiallyeject linear rows of staples from the staple cartridge. A knife ismovably positioned between the linear rows of staples such that when thesurgical stapling apparatus is positioned about tissue and actuated, thetissue is joined and/or simultaneously or nearly simultaneously cut.

SUMMARY

Surgical stapling apparatus are challenging to design, particularly whensuch instruments are required to fit rotation, articulation, and firingwithin small diameter tubes that are as small as 8 mm for providingtight access and/or effectuating thin and/or vascular tissue stapling.When cartridge detection technology is required, adding thesupplementary challenge of incorporating electronic chip technologywithin the limited space provided by the small diameter, design effortsbecome further complicated.

According to one aspect, a surgical stapling apparatus includes ahousing assembly and an adapter assembly. The adapter assembly defines alongitudinal axis and is selectively attachable to the housing assembly.The adapter assembly includes an end effector and an articulationassembly. The articulation assembly includes an articulation drivescrew, an articulation nut threadedly mounted to the articulation drivescrew, an articulation yolk coupled to the articulation nut, and anarticulation tube that is positioned to move in response to movement ofthe articulation nut. Movement of the articulation tube causes the endeffector to articulate relative to the longitudinal axis.

In aspects, the articulation tube may define a slot therein thatreceives the articulation yolk. The articulation tube may support anarticulation joint on a distal end portion thereof. The articulationjoint may be coupled to one or more articulation links that are axiallymovable to articulate the end effector in response to axial movement ofthe articulation tube. The articulation links may include a proximalarticulation link and a distal articulation link. The distalarticulation link may have a proximal end portion that is coupled to theproximal articulation link. The distal articulation link may have adistal end portion that is pivotably coupled to an articulation pin ofthe end effector.

In aspects, the surgical stapling apparatus may further include a firingassembly including a drive beam assembly that is positioned to advancethrough the end effector. The firing assembly may further include afiring drive screw that is positioned within the articulation tube. Thefiring drive screw may be threadedly coupled to a firing nut. The firingnut may be coupled to a firing tube. The firing tube may be axiallyadvanceable through the articulation tube in response to axial movementof the firing nut. The firing nut may be positioned to translate inresponse to rotation of the firing drive screw. A firing rod may besecured to a distal end portion of the firing tube. The firing rod maybe coupled to the drive beam assembly and positioned to advance thedrive beam assembly through the end effector when the firing tubetranslates the firing rod distally.

In aspects, the surgical stapling apparatus may further include arotation assembly having a driver that couples to a pinion. The pinionmay be coupled to an annulus. The annulus may be coupled to a housing ona proximal end portion of the adapter assembly. The housing may becoupled to an outer tube. The outer tube may be coupled to the endeffector, wherein rotation of the driver causes the end effector torotate about the longitudinal axis.

According to one aspect, this disclosure is directed to a surgicalstapling apparatus including a housing assembly, an elongated shaftassembly, an anvil assembly, a cartridge assembly, and an articulationassembly. The elongated shaft assembly defines a longitudinal axis andhas a distal end portion and a proximal end portion. The proximal endportion is selectively attachable to the housing assembly. The anvilassembly is supported on the distal end portion of the elongated shaftassembly. The cartridge assembly is selectively attachable to the anvilassembly to secure the cartridge assembly to the elongated shaftassembly. The articulation assembly includes an articulation drivescrew, an articulation nut threadedly mounted to the articulation drivescrew, an articulation yolk coupled to the articulation nut, and anarticulation tube that is positioned to move in response to movement ofthe articulation nut, wherein movement of the articulation tube causesthe anvil and cartridge assemblies to articulate relative to thelongitudinal axis.

In aspects, the anvil assembly may include an anvil and tissue stops ona proximal end portion thereof. The tissue stops may define cartridgetab slots therethrough, and wherein the cartridge assembly may includeproximal tabs that are receivable within the cartridge tab slots of theanvil assembly to couple the cartridge assembly to the anvil assembly.The cartridge assembly may include a cartridge and a support plate. Theproximal tabs may extend from the support plate.

In aspects, the articulation tube may define a slot therein thatreceives the articulation yolk. The articulation tube may support anarticulation joint on a distal end portion thereof. The articulationjoint may be coupled to one or more articulation links that are movableto articulate the anvil and cartridge assemblies in response to movementof the articulation tube. The one or more articulation links may includea proximal articulation link and a distal articulation link. The distalarticulation link may have a proximal end portion that is coupled to theproximal articulation link. The distal articulation link may have adistal end portion that is pivotably coupled to an articulation pin ofthe anvil assembly.

According to yet another aspect, this disclosure is directed to anadapter assembly of a surgical stapling apparatus. The adapter assemblyincludes a proximal housing, an articulation assembly, an elongatedshaft assembly, and an end effector. The articulation assembly issupported by the proximal housing. The articulation assembly includes anarticulation drive screw, an articulation nut threadedly mounted to thearticulation drive screw, an articulation yolk coupled to thearticulation nut, and an articulation tube positioned to move inresponse to movement of the articulation nut. The elongated shaftassembly is coupled to the proximal housing and defines a longitudinalaxis. The elongated shaft assembly has a proximal end portion and adistal end portion. The end effector is supported on the distal endportion of the elongated shaft assembly and includes an anvil assemblyand a cartridge assembly selectively attachable to the anvil assembly.Rotation of the articulation drive screw causes the end effector toarticulate relative to the longitudinal axis.

In aspects, the adapter assembly may further include a firing assembly.The firing assembly may include a drive beam assembly that is positionedto advance through the cartridge assembly. The firing assembly mayfurther include a firing drive screw that is positioned within thearticulation tube. The firing drive screw may be threadedly coupled to afiring nut. The firing nut may be coupled to a firing tube. The firingtube may be being axially advanceable through the articulation tube inresponse to axial movement of the firing nut. The firing nut may bepositioned to translate in response to rotation of the firing drivescrew.

In aspects, a firing rod may be secured to a distal end portion of thefiring tube. The firing rod may be coupled to the drive beam assemblyand positioned to advance the drive beam assembly through the endeffector when the firing tube translates the firing rod distally.

Other aspects, features, and advantages will be apparent from thedescription, the drawings, and the claims that follow.

BRIEF DESCRIPTION OF DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate aspects of the disclosure and,together with a general description of the disclosure given above andthe detailed description given below, explain the principles of thisdisclosure, wherein:

FIG. 1 is a perspective view of an exemplary surgical stapling apparatusin accordance with the principles of this disclosure;

FIG. 2 is a perspective view of the surgical stapling apparatus of FIG.1 with an elongated shaft assembly of the surgical stapling apparatusshown separate from a housing assembly of the surgical staplingapparatus, the elongated shaft assembly including an end effectorsupported on a distal end portion thereof;

FIG. 3 is an enlarged view of the indicated area of detail shown in FIG.2 , the view illustrating the end effector;

FIG. 4 is a perspective view illustrating a cartridge assembly of theend effector of FIG. 3 separated from an anvil assembly of the endeffector of FIG. 3 ;

FIG. 5 is a perspective view of the anvil assembly of FIG. 4 ;

FIG. 6 is a perspective view, with parts separated, of the cartridgeassembly of FIG. 4 ;

FIG. 7 is an enlarged view of a sled and a lockout spring of thecartridge assembly of FIG. 6 ;

FIG. 8 is an enlarged perspective view of a proximal end portion of theelongated shaft assembly with portions removed for clarity;

FIG. 9 is a perspective view, with parts separated, of the elongatedshaft assembly;

FIG. 10 is a perspective view of the elongated shaft assembly withportions thereof removed for clarity;

FIG. 11 is an enlarged perspective view of the indicated area of detailshown in FIG. 9 ;

FIG. 12 is an enlarged perspective view of the indicated area of detailshown in FIG. 10 ;

FIG. 13 is a perspective view of a distal portion of the elongated shaftassembly with portions thereof shown in phantom for clarity;

FIGS. 14 and 15 are perspective views of the elongated shaft assemblywith portions thereof removed or shown in phantom for clarity;

FIG. 16 is an enlarged view of the indicated area of detail shown inFIG. 15 ;

FIG. 17 is a cross-sectional view of the elongated shaft assembly astaken along section line 17-17 shown in FIG. 2 ;

FIGS. 18 and 19 are enlarged views of the indicated areas of detailshown in FIG. 17 ;

FIG. 20 is a cross-sectional view of the elongated shaft assembly astaken along section line 20-20 shown in FIG. 2 ;

FIG. 21 is a cross-sectional view as taken along section line 21-21shown in FIG. 20 ;

FIG. 22 is a cross-sectional view as taken along section line 22-22shown in FIG. 21 ;

FIGS. 23 and 24 are progressive views illustrating articulation of theend effector relative to a longitudinal axis of the elongated shaftassembly;

FIG. 25 is a cross-sectional view of a proximal portion of the elongatedshaft assembly with portions thereof shown in phantom for clarity;

FIG. 26 is a perspective, cross-sectional view of the elongated shaftassembly as taken along section line 26-26 shown in FIG. 10 ;

FIG. 27 is an enlarged view of the indicated area of detail shown inFIG. 26 ; and

FIG. 28 is an enlarged view of a distal portion of FIG. 26 illustratingthe lockout spring of FIG. 7 in a locked position.

DETAILED DESCRIPTION

Aspects of the disclosed surgical stapling apparatus are described indetail with reference to the drawings, in which like reference numeralsdesignate identical or corresponding elements in each of the severalviews. As commonly known, the term “clinician” refers to a doctor, anurse, or any other care provider and may include support personnel.Additionally, the term “proximal” refers to the portion of structurethat is closer to the clinician and the term “distal” refers to theportion of structure that is farther from the clinician. In addition,directional terms such as front, rear, upper, lower, top, bottom, andthe like are used simply for convenience of description and are notintended to limit the disclosure attached hereto.

In the following description, well-known functions or constructions arenot described in detail to avoid obscuring the present disclosure inunnecessary detail.

Further, although the surgical instrument described herein is providedin connection with a powered laparoscopic surgical stapling apparatusfor brevity, the disclosed surgical instrument can include any powered,manual, or robotically-controlled surgical instruments such as a clipapplier, stitching device, energy-based device (e.g., a bipolar ormonopolar forceps) or the like, and/or other surgical stapling apparatussuch as a circular stapler, a transverse stapler, or an open stapler.For a detailed description of the structure and function of exemplarysurgical stapling apparatus, one or more components of which may beincluded, or modified for use with the disclosed aspects, reference maybe made to U.S. Pat. Nos. 9,713,470; 8,806,973; 8,256,656; 8,157,152;8,070,033 7,819,896; 7,770,774; 7,334,717; 7,128,253; 5,964,394; and5,915,616, the entire contents of each of which are incorporated hereinby reference.

Turning now to FIGS. 1-28 , this disclosure is directed to a surgicalstapling apparatus 10. With reference to FIGS. 1-7 , surgical staplingapparatus 10 includes a housing assembly 12 (which may include one ormore handles that may be manually actuatable to fire surgical staplingapparatus 10) and an elongated shaft assembly 14 that is removablysecured to housing assembly 12. Elongated shaft assembly 14 extendsdistally from housing assembly 12 and defines a longitudinal axis “L”therealong. Elongated shaft assembly 14 includes an adapter assembly 100having a proximal end portion removably secured to housing assembly 12.Adapter assembly 100 extends distally from housing assembly 12 to an endeffector 200. End effector 200 includes an anvil assembly 202 and acartridge assembly 204 that houses a plurality of fasteners (e.g.,staples “S”) (FIG. 6 ) in a reload or cartridge 206 thereof that may bereusable and/or disposable and selectively replaceable.

Anvil assembly 202 of end effector 200 includes an anvil 202 a definingtissue pockets 202 b against which the plurality of staples “S” isformed upon a firing of surgical stapling apparatus 10. Anvil assembly202 further includes tissue stops 202 c on a proximal end portionthereof. The tissue stops 202 c define cartridge tab slots 202 dtherethrough configured to secure cartridge assembly 204 to anvilassembly 202. Anvil assembly 202 further includes articulation posts 202e on a proximal end portion thereof for facilitating pivotal(articulating) movement of end effector 200 relative to longitudinalaxis “L.”

Cartridge assembly 204 of end effector 200 includes an upper cartridgebody 204 a and a lower cartridge body 204 b that support fasteners,pushers 204 c, and a sled 204 d therebetween. Upper cartridge body 204 adefines a plurality of staple slots 205 that supports fasteners therein.A spring lock 204 e is supported on sled 204 d and positioned to springopen from an unlocked position (FIG. 27 ) to a locked position (FIG. 28) when sled 204 d advances distally through cartridge assembly 204 toprevent cartridge assembly 204 from being refired. Cartridge assembly204 further includes a support plate 204 f that couples to upper andlower cartridge bodies 204 a, 204 b. Support plate 204 f includesproximal tabs 204 g on opposite sides thereof that are received withincartridge tab slots 202 d of anvil assembly 202 to secure cartridgeassembly 204 to anvil assembly 202.

End effector 200 further includes a sensor assembly 208 supported byanvil assembly 202. Sensor assembly 208 may include a cartridge IDsensor or cartridge detector 208 a disposed in electrical communicationwith housing assembly 12 (e.g., a controller thereof). The cartridgedetector 208 a is disposed in registration with cartridge tab slots 202d such that cartridge detector 208 a is configured to detect whenproximal tabs 204 g of cartridge assembly 204 are received withincartridge tab slots 202 d of anvil assembly 202 and communicate a signalto a controller 208 c of sensory assembly 208 via a flex cable 208 dextending through elongated shaft assembly 14 (see FIGS. 14-16 ). Thesignal indicative of the securement of the cartridge assembly 204 to theanvil assembly 202. The controller 208 c disposed within a proximal endportion of elongated shaft assembly 14. Flex cable 208 d includes adistal linear undulation 208 e and a proximal rotational coil 208 f thatare coupled together, and to controller 208 c and cartridge detector 208a, via various cable segments 208 g. Controller 208 c is configured toelectrically communicate with housing assembly 12 (e.g., with acontroller 12 c supported within housing assembly 12).

Housing assembly 12 of surgical stapling apparatus 10 includes a housing12 a configured for selective removable receipt of a rechargeablebattery 12 b. Battery 12 b is configured to supply power to electricalcomponents of surgical stapling apparatus 10. Housing 12 a supportscontroller 12 c (e.g., a circuit board) therein. Controller 12 c isconfigured to control various operations of surgical stapling apparatus10 and includes any number of electronic components such as a memory 12d, a processor 12 e, a network interface 12 f, and/or other input/outputmodules 12 g. Controller 12 c may be coupled to a local or remotedisplay device (not shown) for outputting information and/or data suchas a condition of components of surgical stapling apparatus 10 and/ortissue grasped by end effector 200.

Surgical stapling apparatus 10 further includes a drive mechanism 12 hconfigured to drive mechanical and/or electrical components such asrotatable shafts and/or gear components (not shown) within housing 12 ain order to perform various operations of surgical stapling apparatus10. For instance, drive mechanism 12 h may be operable to selectivelyrotate and/or articulate end effector 200 about, and/or relative to, thelongitudinal axis “L” of surgical stapling apparatus 10, as indicated byarrows “A” (FIG. 1 ) and “B” (FIGS. 23 and 24 ), respectively; toselectively move cartridge assembly 204 relative to the anvil assembly202 and/or vice versa, as indicated by arrow “C” to selectively clamptissue; and/or to fire surgical stapling apparatus 10 for fasteningand/or cutting the clamped tissue. Battery 12 b, controller 12 c, and/ordrive mechanism 12 h may be operably coupled to one or more actuators 13a, 13 b, and 13 c such as finger-actuated control buttons, rockerdevices, and/or the like to effectuate various functions of surgicalstapling apparatus 10 such as those described above.

As best seen in FIGS. 8-28 , adapter assembly 100 of elongated shaftassembly 14 includes an outer housing 110 on a proximal end portionthereof and an outer tube 109 that extends distally from outer housing110 to a support assembly 108. Support assembly 108 includes an uppershell 108 a and a lower shell 108 b that couple together to support adrive beam assembly 150 therein. The support assembly 108 has a distalend portion pivotably coupled to a proximal end of end effector 200 toenable end effector 200 to articulate relative to longitudinal axis “L.”Outer housing 110 supports a drive assembly 112 therein. Outer housing110 has a proximal outer housing 110 a and a distal outer housing 110 bthat extends distally from proximal outer housing 110 a. Proximal outerhousing 110 a supports an electrical assembly 110 c and a plurality ofdrive couplers 110 d that electromechanically couple to drive mechanism12 h of housing assembly 12 for effecting rotation, articulation, andfiring of surgical stapling apparatus 10. Electrical assembly 110 c isconfigured to electrically communicate with, for example, controller 12c of housing assembly 12 when adapter 100 is coupled to housing assembly12 and when drive couplers 110 d mechanically engage drive mechanism 12h, which may include, for instance, a plurality of rotatable actuators(shown) to impart mechanical force (e.g., rotational force) throughdrive assembly 112 of adapter assembly 100. Specifically, a firstactuator 110 z is configured to facilitate articulation of end effector200 relative to longitudinal axis “L,” a second actuator 110 y isconfigured to fire the surgical stapling apparatus 10 for clamping,cutting, and fastening tissue, and a third actuator 110 x is configuredto rotate adapter assembly 100 (and thus end effector 200) aboutlongitudinal axis “L” and relative to housing assembly 12. Actuators 110z, 110 y, 110 x are spring biased by springs 121 relative adapterassembly 100. Distal outer housing 110 b includes an upper housing 110 eand a lower housing 110 f that define tab recesses 110 g therein.

A proximal end portion of adapter assembly 100 further includes an innerbody assembly 111 and an actuator mount 113 coupled to inner bodyassembly 111. The inner body assembly 111 and the actuator mount 113 aresupported within outer housing 110.

Adapter assembly 100 of elongated shaft assembly 14 includes anarticulation assembly 120 configured to articulate end effector 200relative to longitudinal axis “L,” a firing assembly 140 configured tofire end effector 200 (e.g., to clamp, fasten, and cut tissue), and arotation assembly 160 configured to rotate end effector 200 aboutlongitudinal axis “L.”

Articulation assembly 120 of adapter assembly 100 includes firstactuator 110 z on a proximal end portion thereof that mechanicallyengages with drive mechanism 12 h of housing assembly 12. Articulationassembly 120 also includes an articulation drive screw 122 that ismechanically coupled to first actuator 110 z. Articulation drive screw122 extends distally from first actuator 110 z and through actuatormount 113. Articulation assembly 120 further includes an articulationnut 124 threadedly coupled to articulation drive screw 122 and axiallyadvanceable therealong. Articulation nut 124 is configured to translatein proximal and/or distal directions, as indicated by arrows “D” and “E”(FIGS. 23 and 24 ), respectively, in response to rotation ofarticulation drive screw 122, as indicted by arrows “F” (FIG. 8 ).Articulation assembly 120 further includes a pair of articulation yolks126 pinned to articulation nut 124 via pins 124 a, 124 b extending fromarticulation nut 124. Pins 124 a, 124 b enable articulation yolks 126 topivot about pins 124 a, 124 b, as indicated by arrows “G” (FIGS. 23 and24 ), when articulation nut 124 axially translates along articulationdrive screw 122. Articulation yolks 126 include a drive plate 126 a andan end plate 126 b. Articulation assembly 120 also includes anarticulation tube 128 supported within outer tube 109 and coupled toarticulation yolks 126 via drive plates 126 a. Drive plates 126 a ofarticulation yolks 126 are received within drive notches 128 a definedwithin a proximal end portion of articulation tube 128. End plates 126 bof articulation yolks 126 are slidably (vertically as indicated byarrows “I” in FIG. 22 ) and rotatably received within a tapered guidechannel 111 a defined within inner body assembly 111. Drive plates 126 aare configured to cause articulation tube 128 to axially translate, asindicated by arrows “H” (FIG. 22 ), as articulation yolks 126 pivotabout articulation nut 124.

Articulation assembly 120 of adapter assembly 100 further includes anarticulation joint 130 coupled to a distal end portion of articulationtube 128, proximal articulation links 132 that have proximal notches 132a coupled to distal tabs 130 a on opposed sides of articulation joint130, and distal articulation links 134 that are coupled to distalnotches 132 b of proximal articulation links 132. Distal articulationlinks 134 include proximal hooks 134 a received within distal notches132 b of proximal articulation links 132 and distal apertures 134 b(FIG. 12 ) defined therethrough that receive articulation posts 202 e ofanvil assembly 202 (see FIG. 5 ). Articulation joint 130 is positionedto provide a wire path channel therethrough for flex cable 208 d.

Firing assembly 140 of adapter assembly 100 includes second actuator 110y on a proximal end portion thereof that mechanically engages with drivemechanism 12 h of housing assembly 12. Firing assembly 140 furtherincludes a firing drive screw 142 that is mechanically coupled to secondactuator 110 y and extends distally therefrom and through inner bodyassembly 111. Firing drive screw 142 is rotatably supported within innerhousing assembly 111 by a bearing assembly 99. A distal portion offiring drive screw 142 is coupled to a proximal end portion of a firingtube 144 via a firing nut 146 threadedly mounted on firing drive screw142 to enable firing nut 146 to translate in response to rotation offiring drive screw 142. Firing nut 146 includes elongated ribs 146 adisposed in spaced-apart relation to one another about an outer surfaceof firing nut 146. Firing nut 146 further includes an elongated lug 146b that extends along an outer surface of firing nut 146 and radiallyfarther outward from the outer surface of firing nut 146 than elongatedribs 146 a to enable firing nut 146 to translate along articulation tube128 as elongated lug 146 b of firing nut 146 slides through a slidechannel 128 b (FIG. 9 ) defined through articulation tube 128. In thisregard, elongated lug 146 b functions as a keel to prevent rotations asfiring nut 146 rides along slide channel 128 b of articulation tube 128.Firing tube 144 includes a split collar 144 a on a proximal end portionthereof that interlocks with elongated ribs 146 a of firing nut 146 toprevent rotation of firing nut 146 about longitudinal axis “L” whenfiring drive screw 142 is rotated to distally advance firing tube 144,as indicated by arrows “J” (FIG. 25 ). This interlocking structure ofthe split collar 144 a and elongated ribs 146 a of firing nut 146functions as a collet and provides a low-profile design that enablesfiring drive screw 142 to have an increased diameter such as would besuitable for a 12 mm passage design (as opposed to the smaller diameter8 mm passage design for which surgical stapling apparatus 10 may beutilized). A distal portion of firing tube 144 is secured to a proximalend portion of a firing rod 148 by an interlocking joint 149. Theinterlocking joint 149 functions to reduce overall diameter and includesa female member 144 b on a distal end portion of firing tube 144 and amale member 148 a on proximal end portion of firing rod 148. A distalend portion of firing rod 148 is mechanically coupled to a proximal endportion of drive beam assembly 150 via a transverse rod 148 b (FIG. 18 )supported on distal end portion of firing rod 148.

Drive beam assembly 150 of firing assembly 140 includes a plurality oflaminates 150 a, 150 b, 150 c having proximal hooks 151 that are securedto a distal end portion of firing rod 148. The laminates 150 a, 150 b,150 c have distal end portions that are secured to a drive beam 152including a knife 152 a thereon. Drive beam 152 is selectively distallyadvanceable through end effector 200 to drive sled 204 d therethroughwhen firing rod 148 advances laminates 150 a, 150 b, 150 c. When drivebeam 152 distally advances, anvil and cartridge assemblies 202, 204 areconfigured to move from an open position to a closed position to clampon tissue therebetween. Further distal advancement of drive beam 152causes knife 152 a of drive beam 152 to cut the clamped tissue as drivebeam 152 engages and distally advances drive sled 204 d throughcartridge assembly 204 for causing fasteners supported therein be formedagainst anvil assembly 202 and secured to the clamped tissue betweenanvil and cartridge assemblies 202, 204. Once fired, drive beam assembly150 can be retracted proximally away from sled 204 d and proximal tospring lock 204 e of cartridge assembly 204 such that spring lock 204 e,which is disposed in an open or locked position (FIG. 28 ) after sled204 d is distally advanced, prevents further distal advancement of drivebeam assembly 150 after drive beam assembly 150 is retracted to aninitial position thereof.

Rotation assembly 160 of adapter assembly 100 includes third actuator110 x on a proximal end portion thereof that mechanically engages withdrive mechanism 12 h of housing assembly 12. Rotation assembly 160further includes a driver 162 that is mechanically coupled to thirdactuator 110 x and extends distally therefrom through actuator mount 113and into inner body assembly 111. Driver 162 has a non-circular distaldrive 162 a to facilitate non-rotational coupling to a pinion 164 sothat pinion 164 rotates with driver 162 as third actuator 110 x isrotated. Pinion 164 (e.g., teeth on an outer surface thereof) isenmeshed with an annulus 166 (e.g., teeth on an inner surface thereof)having opposed mounting tabs 166 a extending from diametrically opposedends of an outer surface of annulus 166. Opposed mounting tabs 166 a aremounted within tab recesses 110 g defined within distal outer housing110 b. Tabs 166 a of annulus 166 secure annulus 166 to upper housing 110e and to lower housing 110 f of distal outer housing 110 b so thatdistal outer housing 110 b rotates relative to proximal outer housing110 a as annulus 166 is rotated by pinion 164. Rotation of distalhousing 110 b causes outer tube 109 and end effector 200 to rotate aboutlongitudinal axis “L.” Rotation assembly 160 further includes a rotationring 168 that receives annulus 166 and is supported by a proximal endportion of inner body assembly 111. Rotation ring 168 includes a stoptab 168 a on an outer surface thereof that is positioned to engage astop tab 111 a depending from inner body assembly 111, whereby stop tabs168 a, 111 a are positioned to function as a slip stop that enablesrotation assembly 160 to rotate up to about 700 degrees. Rotation ring168 is configured to rotate at half speed (e.g., float) such thatrotation ring 168 enables two full rotations (e.g., up to about 700degrees) minus a thickness of stop tab 168 a thereof.

The various aspects disclosed herein may also be configured to work withrobotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe clinician and allow remote operation (or partial remote operation)of surgical instrumentation. Various robotic arms, gears, cams, pulleys,electric and mechanical motors, etc. may be employed for this purposeand may be designed with a robotic surgical system to assist theclinician during an operation or treatment. Such robotic systems mayinclude remotely steerable systems, automatically flexible surgicalsystems, remotely flexible surgical systems, remotely articulatingsurgical systems, wireless surgical systems, modular or selectivelyconfigurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of clinicians may prep the patient forsurgery and configure the robotic surgical system with one or more ofthe instruments disclosed herein while another clinician (or group ofclinicians) remotely controls the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled clinician may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients. For a detailed description of exemplarymedical workstations and/or components thereof, reference may be made toU.S. Pat. Application Publication No. 2012/0116416, and PCT ApplicationPublication No. WO2016/025132, the entire contents of each of which areincorporated by reference herein.

Moreover, the disclosed electronic structure such as the controller(s),can include any suitable electrical components for operating thedisclosed surgical stapling apparatus or components thereof. Suchelectrical components can include, for example, one or more controllersand/or circuitry, which may include or be coupled to one or more printedcircuit boards. As used herein, the term “controller” includes“processor,” “digital processing device” and like terms, and are used toindicate a microprocessor or central processing unit (CPU). The CPU isthe electronic circuitry within a computer that carries out theinstructions of a computer program by performing the basic arithmetic,logical, control and input/output (I/O) operations specified by theinstructions, and by way of non-limiting examples, include servercomputers. In some aspects, the controller includes an operating systemconfigured to perform executable instructions. The operating system is,for example, software, including programs and data, which manageshardware of the disclosed surgical stapling apparatus and providesservices for execution of applications for use with the disclosedsurgical stapling apparatus. Those of skill in the art will recognizethat suitable server operating systems include, by way of non-limitingexamples, FreeBSD, OpenBSD, NetBSD®, Linux, Apple® Mac OS X Server®,Oracle® Solaris®, Windows Server®, and Novell® NetWare®. In someaspects, the operating system is provided by cloud computing.

In some aspects, the term “controller” may be used to indicate a devicethat controls the transfer of data from a computer or computing deviceto a peripheral or separate device and vice versa, and/or a mechanicaland/or electromechanical device (e.g., a lever, knob, etc.) thatmechanically operates and/or actuates a peripheral or separate device.

In aspects, the controller includes a storage and/or memory device. Thestorage and/or memory device is one or more physical apparatus used tostore data or programs on a temporary or permanent basis. In someaspects, the controller includes volatile memory and requires power tomaintain stored information. In various aspects, the controller includesnon-volatile memory and retains stored information when it is notpowered. In some aspects, the non-volatile memory includes flash memory.In certain aspects, the non-volatile memory includes dynamicrandom-access memory (DRAM). In some aspects, the non-volatile memoryincludes ferroelectric random-access memory (FRAM). In various aspects,the non-volatile memory includes phase-change random access memory(PRAM). In certain aspects, the controller is a storage deviceincluding, by way of non-limiting examples, CD-ROMs, DVDs, flash memorydevices, magnetic disk drives, magnetic tapes drives, optical diskdrives, and cloud-computing based storage. In various aspects, thestorage and/or memory device is a combination of devices such as thosedisclosed herein.

In some aspects, the controller includes a display to send visualinformation to a user. In various aspects, the display is a cathode raytube (CRT). In various aspects, the display is a liquid crystal display(LCD). In certain aspects, the display is a thin film transistor liquidcrystal display (TFT-LCD). In aspects, the display is an organic lightemitting diode (OLED) display. In certain aspects, on OLED display is apassive-matrix OLED (PMOLED) or active-matrix OLED (AMOLED) display. Inaspects, the display is a plasma display. In certain aspects, thedisplay is a video projector. In various aspects, the display isinteractive (e.g., having a touch screen or a sensor such as a camera, a3D sensor, a LiDAR, a radar, etc.) that can detect userinteractions/gestures/responses and the like. In some aspects, thedisplay is a combination of devices such as those disclosed herein.

The controller may include or be coupled to a server and/or a network.As used herein, the term “server” includes “computer server,” “centralserver,” “main server,” and like terms to indicate a computer or deviceon a network that manages the surgical stapling apparatus, componentsthereof, and/or resources thereof. As used herein, the term “network”can include any network technology including, for instance, a cellulardata network, a wired network, a fiber optic network, a satellitenetwork, and/or an IEEE 802.11a/b/g/n/ac wireless network, among others.

In various aspects, the controller can be coupled to a mesh network. Asused herein, a “mesh network” is a network topology in which each noderelays data for the network. All mesh nodes cooperate in thedistribution of data in the network. It can be applied to both wired andwireless networks. Wireless mesh networks can be considered a type of“Wireless ad hoc” network. Thus, wireless mesh networks are closelyrelated to Mobile ad hoc networks (MANETs). Although MANETs are notrestricted to a specific mesh network topology, Wireless ad hoc networksor MANETs can take any form of network topology. Mesh networks can relaymessages using either a flooding technique or a routing technique. Withrouting, the message is propagated along a path by hopping from node tonode until it reaches its destination. To ensure that all its paths areavailable, the network must allow for continuous connections and mustreconfigure itself around broken paths, using self-healing algorithmssuch as Shortest Path Bridging. Self-healing allows a routing-basednetwork to operate when a node breaks down or when a connection becomesunreliable. As a result, the network is typically quite reliable, asthere is often more than one path between a source and a destination inthe network. This concept can also apply to wired networks and tosoftware interaction. A mesh network whose nodes are all connected toeach other is a fully connected network.

In some aspects, the controller may include one or more modules. As usedherein, the term “module” and like terms are used to indicate aself-contained hardware component of the central server, which in turnincludes software modules. In software, a module is a part of a program.Programs are composed of one or more independently developed modulesthat are not combined until the program is linked. A single module cancontain one or several routines, or sections of programs that perform aparticular task.

As used herein, the controller includes software modules for managingvarious aspects and functions of the disclosed surgical staplingapparatus or components thereof.

The disclosed surgical stapling apparatus may also utilize one or morecontrollers to receive various information and transform the receivedinformation to generate an output. The controller may include any typeof computing device, computational circuit, or any type of processor orprocessing circuit capable of executing a series of instructions thatare stored in memory. The controller may include multiple processorsand/or multicore central processing units (CPUs) and may include anytype of processor, such as a microprocessor, digital signal processor,microcontroller, programmable logic device (PLD), field programmablegate array (FPGA), or the like. The controller may also include a memoryto store data and/or instructions that, when executed by the one or moreprocessors, cause the one or more processors to perform one or moremethods and/or algorithms.

Any of the herein described methods, programs, algorithms, or codes maybe converted to, or expressed in, a programming language or computerprogram. The terms “programming language” and “computer program,” asused herein, each include any language used to specify instructions to acomputer, and include (but is not limited to) the following languagesand their derivatives: Assembler, Basic, Batch files, BCPL, C, C+, C++,Delphi, Fortran, Java, JavaScript, machine code, operating systemcommand languages, Pascal, Perl, PL1, scripting languages, Visual Basic,metalanguages which themselves specify programs, and all first, second,third, fourth, fifth, or further generation computer languages. Alsoincluded are database and other data schemas, and any othermeta-languages. No distinction is made between languages which areinterpreted, compiled, or use both compiled and interpreted approaches.No distinction is made between compiled and source versions of aprogram. Thus, reference to a program, where the programming languagecould exist in more than one state (such as source, compiled, object, orlinked) is a reference to any and all such states. Reference to aprogram may encompass the actual instructions and/or the intent of thoseinstructions.

As can be appreciated, securement of any of the components of thedisclosed apparatus can be effectuated using known securement techniquessuch welding, crimping, gluing, fastening, etc. Also, any of thedisclosed structure can include any suitable conductive material (e.g.,metallic), semi-conductive material (e.g., silicone), and/ornonconductive/insulative material (e.g., plastic).

Persons skilled in the art will understand that the structures andmethods specifically described herein and illustrated in theaccompanying figures are non-limiting exemplary aspects, and that thedescription, disclosure, and figures should be construed merely asexemplary of particular aspects. It is to be understood, therefore, thatthis disclosure is not limited to the precise aspects described, andthat various other changes and modifications may be effectuated by oneskilled in the art without departing from the scope or spirit of thedisclosure. Additionally, it is envisioned that the elements andfeatures illustrated or described in connection with one exemplaryaspect may be combined with the elements and features of another withoutdeparting from the scope of this disclosure, and that such modificationsand variations are also intended to be included within the scope of thisdisclosure. Indeed, any combination of any of the disclosed elements andfeatures is within the scope of this disclosure. Accordingly, thesubject matter of this disclosure is not to be limited by what has beenparticularly shown and described.

1-20. (canceled)
 21. A surgical stapling apparatus, comprising: ahousing assembly; and an adapter assembly defining a longitudinal axisand selectively attachable to the housing assembly, the adapter assemblyincluding: an end effector; and a firing assembly including a drive beamassembly and a firing drive screw, the firing drive screw coupled to afiring tube by a firing nut for enabling the drive beam assembly toadvance through the end effector.
 22. The surgical stapling apparatus ofclaim 21, wherein the firing drive screw is threadedly coupled to thefiring nut.
 23. The surgical stapling apparatus of claim 22, wherein thefiring nut translates in response to rotation of the firing drive screw.24. The surgical stapling apparatus of claim 23, wherein the firing nutincludes elongated ribs that interlock with a split collar of the firingtube to prevent rotation of the firing nut.
 25. The surgical staplingapparatus of claim 24, wherein a firing rod is secured to a distal endportion of the firing tube.
 26. The surgical stapling apparatus of claim25, wherein the firing rod is coupled to the drive beam assembly. 27.The surgical stapling apparatus of claim 26, wherein the firing rod ispositioned to advance the drive beam assembly through the end effectorwhen the firing tube translates the firing rod distally.
 28. Thesurgical stapling apparatus of claim 21, further comprising a rotationassembly having a driver coupled to a pinion, and wherein rotation ofthe driver causes the end effector to rotate about the longitudinalaxis.
 29. The surgical stapling apparatus of claim 28, wherein thepinion is coupled to an annulus and the annulus is coupled to a housingon a proximal end portion of the adapter assembly.
 30. The surgicalstapling apparatus of claim 29, wherein the housing is coupled to anouter tube and the outer tube is coupled to the end effector.
 31. Asurgical stapling apparatus, comprising: a housing assembly; anelongated shaft assembly defining a longitudinal axis and having adistal end portion and a proximal end portion, the proximal end portionselectively attached to the housing assembly; an anvil assemblysupported on the distal end portion of the elongated shaft assembly; acartridge assembly selectively attached to the anvil assembly to securethe cartridge assembly to the elongated shaft assembly; and a firingdrive screw coupled to a firing nut, the firing nut coupled to a firingtube, the firing tube coupled to a firing rod, the firing rod positionedto advance a drive beam assembly through the cartridge assembly.
 32. Thesurgical stapling apparatus of claim 31, wherein the firing tube isaxially advanceable in response to axial movement of the firing nut. 33.The surgical stapling apparatus of claim 32, wherein the firing nuttranslates in response to rotation of the firing drive screw.
 34. Thesurgical stapling apparatus of claim 31, further comprising anarticulation tube that is moveable to cause the anvil and cartridgeassemblies to articulate relative to the longitudinal axis.
 35. Thesurgical stapling apparatus of claim 34, wherein the firing drive screwis disposed within the articulation tube.
 36. The surgical staplingapparatus of claim 31, wherein the anvil assembly includes anvil tissuestops defining cartridge tab slots therethrough, and wherein thecartridge assembly includes proximal tabs that are receivable within thecartridge tab slots of the anvil assembly to couple the cartridgeassembly to the anvil assembly.
 37. An adapter assembly of a surgicalstapling apparatus, the adapter assembly comprising: a proximal housing;an elongated shaft assembly coupled to the proximal housing and defininga longitudinal axis, the elongated shaft assembly having a proximal endportion and a distal end portion; an end effector supported on thedistal end portion of the elongated shaft assembly, the end effectorincluding an anvil assembly and a cartridge assembly selectivelyattached to the anvil assembly; and a firing assembly including a firingdrive screw threadedly coupled to a firing nut, the firing nut coupledto a firing tube, the firing nut positioned to translate when the firingdrive screw rotates to cause the firing tube to translate for firing theend effector.
 38. The adapter assembly of claim 37, wherein the firingtube is axially advanceable in response to axial movement of the firingnut.
 39. The adapter assembly of claim 38, wherein a firing rod issecured to the firing tube, the firing rod coupled to a drive beamassembly and positioned to advance the drive beam assembly through theend effector when the firing tube translates the firing rod distally.40. The adapter assembly of claim 37, further comprising a rotationassembly having a driver coupled to a pinion, and wherein rotation ofthe driver causes the end effector to rotate about the longitudinalaxis.